Methods for placing a stent-graft to cover collateral vessels in lower extremity vasculature

Abstract

A method of diverting fluid flow from a first vessel including an occlusion to a second vessel includes deploying a prosthesis at least partially in a fistula and making valves in the second vessel incompetent. Making the valves in the second vessel incompetent includes at least one of using a reverse valvulotome to cut the valves, inflating a balloon, expanding a stent, and lining the second vessel with a stent.

What is claimed is: 
     
       1. A method of modifying a vessel including covering collateral vessels of the vessel, the method comprising:
 forming a fistula between a first vessel and the vessel, wherein the first vessel is an artery and the vessel is a vein, wherein forming the fistula comprises:
 inserting a first catheter into the first vessel, the first catheter comprising a needle being configured to radially extend from the first catheter; 
 inserting a second catheter into the vessel, the second catheter comprising an expandable device; and 
 extending the needle from the first catheter, wherein extending the needle comprises:
 exiting the first vessel, 
 traversing interstitial tissue between the first vessel and the vessel, 
 entering the vessel, and 
 puncturing the expandable device to confirm advancement of the needle into the vessel; 
 
 
 advancing a guidewire from the first vessel, through the needle, and into the vessel; 
 deploying a prosthesis at least partially in the fistula, wherein deploying the prosthesis comprises:
 tracking the prosthesis over the guidewire, and 
 expanding the prosthesis with a balloon, 
 wherein after deploying the prosthesis, blood is diverted from the first vessel to the vessel through the prosthesis; and 
 
 making the valves in the vessel incompetent, wherein making the valves in the vessel incompetent comprises positioning a stent-graft in the vessel,
 wherein positioning the stent-graft in the vessel comprises covering the collateral vessels of the vessel, 
 wherein the stent-graft is separate from the prosthesis, and 
 wherein a proximal segment of the stent-graft longitudinally overlaps a distal segment of the prosthesis. 
 
 
     
     
       2. The method of  claim 1 , wherein the proximal segment of the stent-graft is radially outward of the distal segment of the prosthesis after positioning the stent-graft and after deploying the prosthesis. 
     
     
       3. The method of  claim 1 , wherein making the valves incompetent comprises advancing a cutting balloon or valvulotome in the vessel. 
     
     
       4. The method of  claim 1 ,
 wherein making the valves incompetent comprises advancing a cutting balloon or valvulotome in the vessel, 
 wherein positioning the stent-graft in the vessel is before deploying the prosthesis, and 
 wherein the proximal segment of the stent-graft is radially outward of the distal segment of the prosthesis after positioning the stent-graft and after deploying the prosthesis. 
 
     
     
       5. A method of modifying a vessel including covering collateral vessels of the vessel, the method comprising:
 forming a fistula between a first vessel and the vessel, wherein forming the fistula comprises:
 inserting a catheter into the first vessel, the catheter comprising a needle configured to radially extend from the catheter, and 
 extending the needle from the catheter, wherein extending the needle comprises exiting the first vessel, traversing interstitial tissue between the first vessel and the vessel, and entering the vessel; 
 
 deploying a prosthesis at least partially in a fistula between the first vessel and the vessel, wherein after deploying the prosthesis, blood is diverted from the first vessel to the vessel through the prosthesis; and 
 placing a stent-graft in the vessel, 
 wherein placing the stent-graft in the vessel comprises:
 expanding the stent-graft, and 
 covering the collateral vessels of the vessel including making the valves in the vessel incompetent, 
 wherein the stent-graft is separate from the prosthesis, and 
 wherein a proximal segment of the stent-graft longitudinally overlaps a distal segment of the prosthesis. 
 
 
     
     
       6. The method  claim 5 , wherein the prosthesis comprises a first portion configured to anchor in the first vessel, a second portion configured to anchor in and line a length of the vessel, and a third portion longitudinally between the first portion and the second portion. 
     
     
       7. The method  claim 6 , wherein the first portion and the third portion are separate from the second portion. 
     
     
       8. The method  claim 7 , wherein the third portion longitudinally overlaps the second portion. 
     
     
       9. The method  claim 7 , wherein the third portion is tapered after deploying the prosthesis. 
     
     
       10. The method of  claim 5 , further comprising advancing a cutting balloon or valvulotome in the vessel. 
     
     
       11. The method  claim 5 , further comprising advancing a cutting balloon in the vessel,
 wherein the prosthesis comprises a first portion configured to anchor in the first vessel, a second portion configured to anchor in and line a length of the vessel, and a third portion longitudinally between the first portion and the second portion, 
 wherein the first portion and the third portion are separate from the second portion, 
 wherein the third portion longitudinally overlaps the second portion, and 
 wherein the third portion is tapered after deploying the prosthesis. 
 
     
     
       12. A method of modifying a vessel including covering collateral vessels of the vessel, the method comprising:
 putting a first stent-graft in the vessel; and 
 deploying a prosthesis at least partially in a fistula between a first vessel and the vessel, wherein after deploying the prosthesis, blood is diverted from the first vessel to the vessel through the prosthesis, 
 wherein putting the first stent-graft in the vessel comprises covering the collateral vessels of the vessel including making the valves in the vessel incompetent, 
 wherein the first stent-graft is separate from the prosthesis, and 
 wherein a first segment of the first stent-graft longitudinally overlaps a second segment of the prosthesis. 
 
     
     
       13. The method of  claim 12 , wherein the vessel comprises a proximal tibial vein, and wherein putting the first stent-graft in the vessel comprises lining an entire length of the proximal tibial vein with the first stent-graft. 
     
     
       14. The method of  claim 13 , wherein the first stent-graft has a length between 2 cm and 30 cm. 
     
     
       15. The method of  claim 12 , further comprising advancing a cutting balloon or valvulotome in the vessel. 
     
     
       16. The method of  claim 12 , wherein the first segment of the first stent-graft is radially outward of the second segment of the prosthesis after putting the first stent-graft and after deploying the prosthesis. 
     
     
       17. The method of  claim 12 , further comprising putting a second stent-graft in the vessel, wherein a first segment of the second stent-graft longitudinally overlaps a second segment of the first stent-graft. 
     
     
       18. The method of  claim 17 , wherein the second stent-graft has a length between 2 cm and 30 cm. 
     
     
       19. The method of  claim 17 , wherein the first segment of the second stent-graft is radially outward of the second segment of the first stent-graft after putting the first stent-graft and after putting the second stent-graft. 
     
     
       20. The method of  claim 12 , further comprising:
 putting a second stent-graft in the vessel, and 
 advancing a cutting balloon or valvulotome in the vessel, 
 wherein a first segment of the second stent-graft longitudinally overlaps a second segment of the first stent-graft, 
 wherein putting the second stent-graft in the vessel comprises covering the collateral vessels of the vessel, 
 wherein the second stent-graft is separate from the prosthesis, and 
 wherein the first segment of the second stent-graft is radially outward of the second segment of the first stent-graft after putting the first stent-graft and after putting the second stent-graft.